Monday, January 29, 2018

Healthcare Costs

A competitive marketplace, even one including democratic capitalism and intellectual property enforcement, would allow for a vast reduction in healthcare costs. Imagine that you break a limb, and in response to your injury, you could choose to visit an AMA-approved facility (assume for the purposes of example that it still exists) and wait for 5-75 minutes to fill in a form, have an X-ray, describe your adventure to a nurse, describe it again to a summoned doctor, and receive the setting and casting of said limb. You receive a notch on your chart, pay your co-pay, and go home. Your hospital experience may or may not include the participation in or potential observation of various experiences which you may or may not feel are necessary components of addressing such injury, magnified by various affirmations that you had assessed your experience correctly and that it wouldn't conflict with and/or affect other conditions which you did or didn't know you had.

Alternatively, posit that you can choose to visit a limb center, maybe wait up to six minutes for a technician to be available, then chew a painkiller and have the limb set, then decide whether you feel like visiting the optional casting shop or taking standard in white. Home in half an hour, costs a couple hundred bucks out-of-pocket or is free if you buy a comprehensive physical emergency insurance for a couple hundred a year, and life goes on.

A certain variety of consumer, prevalent nowadays, could imagine a preference for the former, based upon hypothetical afflictions with which the breaking of said limb might cause affections or alterations; the computer system at the limb center can provide a simple series of less than one minute Q&As that would cover all that, particularly if cross-linked to the computers at other similar centers, but presume it's disconnected and can refer you to a different place if it somehow affects some condition in ways in which the limb should not be set there (~0%).

The AMA does, rather shamelessly and violently, employ trauma monopolization over the market, to the extent that it takes massive religion-level inculcation to make consumers docile and accepting. "Of course it takes a minimum of ten years of training after high school to be an entry-level setting associate, duh." The establishment of violently enforced "treatment deserts" throughout monopoly territory is so commonplace as to not be worth recalling, let alone discussing, and the expansion of consideration of types of affected trauma treatments (almost all), from the mundane to the exotic, makes the problem expand to colossal proportions. A degree of familiarity with "doctor shortages," particularly if added to an understanding of the way that the consequential deaths related to (caused by) lacking approval for such procedures--a drug; a scan; a series of drugs or tests waiting a minute or a hundred twenty or weeks for potential use to be evaluated--leads to more of an understanding of how brutal the healthcare cartel is with its thralls, even quite wealthy ones. How many people have died months or years later from an advancing condition before some scanning machine--deliberately sold in small quantities to participating centers due to a variety of factors pricing care out of the imagined reach of the masses--can become available for an advanced priest to order its use, is a not insignificant, but historically non-verifiable, quantity. Procedure's granting of its own innocence is, this time, even retroactively responsible; the body count is, like cellular motivations for division, free of the threat of being proven. That sickening feeling of waiting to be addressed while something evil grows inside in uncertain ways can never be quantified, nor can the potential developments during unseen periods. We can, in 2018, look back at those burned or hanged by the governing church, rightly or wrongly, but we cannot track the suicides, irresponsible deaths related to (caused by) ostracism, et cetera, which, absent a time machine, are only speculatively, never provably, astronomically greater. Similarly, we cannot track the number of careless (not as the word is commonly employed now, but more literally) overpass visits of those who've heard that the lump wasn't caught in time, which remain indistinguishable, as contrasted with cancer-related deaths in approved facilities and related venues. The costs are not trackable, and as we grow better at tracking, so too do we grow better at disguising.

A hospital not staffed with a bloated quantity of employees whose function is primarily to fill time and distract "customers" from violating physicians' time stands in clear contrast to a hypothetical, disallowed set of job descriptions and treatment results from a million less-educated specialists. Perhaps an extremely overestimated (particularly when computers check all conflicts for even the loftiest priests anyway) ten thousand false diagnoses leading to death could be weighed against the likely hundreds of thousands of deaths caused by prearranged administrative bloat. The computer-mediated mistakes made by a legion of somewhat-dumb high school dropouts who still know how to search the computer and take apart a carburetor would actually number quite few, contrasted with the much higher number of deadly oversights routinely engaged in by a cozened class of modern priests who midnight-crammed for a week to barely pass a simplified trigonometry exam that they no longer remember. An aging population may join the strengthening computer in addressing some of these problems as a suitable distraction, yet this does nothing regarding justice for the already dead and currently dying, nor those who must perish on behalf of some form of witnessed scarcity to create a plausible veneer of studious in-demand-ness to correspond with cartel-rule as it exists or will exist.

Within the confines of such rule, ample opportunities present themselves for critique; even cartel-supporting paths of inquiry offer simple means of improving effectiveness which would, along the sideline, save a few million lives. More interesting at present is the unexplored question of pricing and availability. We may wonder, given a paucity of physicians, why each licensed, approved school can't graduate at least fifty more, rather than turning eminently eligible candidates away in yearly droves to become elementary science teachers; the trend of obedient hydras of medicine to expose to patients, extravagantly train, and offer concessatory diplomas and then licenses and employment based on appearance quotas both concealed and not, speaks its own set of volumes about the desire for quality of care rather than social power.

Beyond all of this, we look to the simplest sort of economics, namely, the pricing of various treatments for ailments. Maintaining the cartel's membership systems is a step toward this, along with, of course, the ability to grant and withdraw facility or potential facility licenses to cooperate. Yet in a more visceral way, the state of modern healthcare seems to face an impossibility, where two massive and powerful groups have not come to a clash. An insurance industry, along with the mechanical providers of care, are at seeming odds over the issue of pricing, whereby the insurance industry's massive capital, legislative and judicial purchasing power, and immense reach seem impossibly stymied by this comparatively small band of rogue mechanics. We have not seen, say, an insurer establishing (and suing for the right to run and maintain) its own schools, service facilities, pharmacies, et cetera, such that a drastic cost reduction could be effected. By founding a township, cooperating with some unrelated industry to provide jobs, and buying relevant local legislation, such an insurer could achieve care and care-providers that offered dollar-drugs and twenty bucks for a brief annual consultation, mostly headed by nurses paid $54K a year for three patients an hour. Aside from such speculation, and presuming the accuracy of all arguments about possibility and access potential, an insurer could, with sixty million consumers on its rolls, demand lower pricing, threatening to sponsor relocation costs for physicians willing to defy pricing arrangements, or choose other providers--who, for sixty million roughly guaranteed consumers, would respond--to vend their offered services. Even if all realism about opening its own hospital and subsidiary clinics in a company town were dismissed, an insurer could, at the least, gather a panoply of sob stories, sponsor articles and posters, approach a local legislature, and achieve in totally open ways comparable results of paying less per service.

And yet, insurers have not done so. Like bought boxers struggling not to take a dive too fast, insurers have "negotiated" in a way that pays extravagantly for even simple procedures, uniting across corporate faces to maintain ridiculously high pricing levels. Insurers could partner with the government, using nationwide legislation to become subsidiary sole providers of a national insurance system, and they have the cash to overrun the staunchest of Congresspeople, should they wish to control the entire industry. This seeming battle of giants has never materialized, as though a billions-dollar industry seeking profit is unaware of its own potential gains and current losses; insurers relentlessly agree to pricing schemes which take into account staff and facilities costs in want of an extreme challenge, often requiring paid referral appointments for conditions that Google already understands, and accepting the costs of a pricier business model even decades after the advent of a publicly-accessible healthcare-internet that should have shattered any final pretense at mysterious knowledge. Amazingly, after self-diagnosis became nearly as accurate for the illiterate and their helpful friends investigating minor conditions, provider rates have become more expensive, provider status equally costly, and the insurers--who supposedly pay for this all--remained silent.

The answer to the conundrum, like all the other heads of the monstrous death-machine which wraps about the post-industrial world, is found in the joint ownership of provider and insurer. Insurers make a profit, and pay so eagerly, because they are paying themselves. Competition only makes a pretense at existing, while in actuality it doesn't exist, because the system's feigned privacy makes it immensely more profitable, right now, than a feigned nationalization. By owning both payer and provider, a deceit is orchestrated whereby a common consumer pays a false ally to get the best deals by being taxed for maintaining atrociously high costs for an undying killing machine. This perspective seems science fiction in times of health, while merely tithing operational machinery for others' care based on promises of you being cared for, but when combined with closer acquaintance through employment or aging, and it takes months to find the right operation for which to pay cash for a procedure of ultimate importance, the careless features of the system can be better discerned, and all the soothing promises of paying now for care later become, like crumbling old age pensions, more honestly viewed.

Fiscally empowering a government to, say, take serious action on a health issue (say, mandatory housing for eliminating optional hyper-obesity), or have more MRI machines around, would be not only a civic positive, and a modern national prerequisite, they would be vast enough in scope to serve themselves as a primary issue. In truth, such fringe benefits would only be of secondary consideration when compared to the end to price-gouging and innovation-hampering that such a takeover would entail. Indeed, ending cartel tyranny would be so immensely profitable in tertiary issues that, besides securing discarded lives, such a revolution would "pay for itself" at least a hundred times over.